AB0775 Efficacy, safety and survival of Secukinumab in spondyloarthritis.
Authors: M. López I Gómez, N. Del Val del Amo, L. Ibarrola, U. Astigarraga Urkia, J. Mendizabal, G. Sada, S. Garcia Perez, I. Paniagua Zudaire, L. Garrido Courel, L. Horcada, R. Gutierrez, C. Fito-Manteca
Journal: Annals of the Rheumatic Diseases (2022)

Background Secukinumab (SCK) is a fully human monoclonal antibody that selectively inhibits IL-17A indicated for both axial and peripheral spondyloarthritis (SpA) and psoriatic arthritis (PsA). In this paper we present our experience with SCK since its approval, in a tertiary hospital. Objectives To describe the efficacy, survival and safety of SCK treatment in real clinical practice in patients with SpA and PsA. Methods We performed a descriptive, retrospective analysis of patients diagnosed with SpA according to ASAS criteria and PsA according to CASPAR criteria. For this purpose, data were collected from the medical records of 75 patients treated with SCK in the rheumatology service. To evaluate efficacy in the Spa group, analytical variables (C-reactive protein (CRP)), the Ankylosing Spondylitis Disease Activity Score (ASDAS) scale and the patient’s visual analog scale (VAS) were analyzed. In the PA group, VAS and CRP were assessed at baseline and at 12 months. Survival was evaluated with respect to the causes of drug discontinuation and its association with individual baseline characteristics, such as metabolic syndrome. Safety was evaluated by analyzing intercurrent infections or neoplasms requiring discontinuation. Results Seventy-five patients with spondyloarthritis included in treatment with SCK were analyzed, 40 had Spa and 34 had PAs. The mean age at diagnosis was 45.1 years (SD 11.3) and the median time from diagnosis to onset of SCK was 4.5 years (IQR 1-10) (Table 1). Table 1. Baseline characteristics SpA APs Total Age at diagnosis 45.1 (SD11.8) 44.9 (SD10.9) 45.1 (SD11.3) Age at begging of SCK 53.5 (SD 9.3) 52.2 (SD 10) 52.9 (9.6DE) Hypertension 10 (25.0%) 10 (29.4%) 20 (27.0%) Dyslipidaemia 17 (42.5%) 17 (51.5%) 34 (46.6%) Diabetes mellitus 5 (12.5%) 6 (17.6%) 11 (14.9%) Body Mass Index 27.9 (SD4.4) 30.5 (SD8.4) 29.2 (SD6.7) Tobacco 14 (35.0%) 10 (29.4%) 24 (32.4%) Cardiovascular disease 5 (12.5%) 2 (5.9%) 7 (9.5%) Previous sDMARD -Methotrexate 13 (32.5%) 24 (70.6%) 37 (50%) -Leflunomide 1.7% (15%) 12 (35.3%) 18 (24.2%) Initial corticosteroids 7 (18.4%) 15 (44.1%) 22 (30.6%) Fifty-seven patients (76%) were on treatment with anti-TNF prior to SCK initiation. The mean number of anti-TNF prior to SCK was 1.8 (SD 1.2). Twenty-six patients (35.1%) received were on treatment with SCK at a dose of 150 mg and 48 (64.9%) with 300 mg every 4 wk. The mean CRP before starting SCK was 8.46 mg/L (SD 18.38) and VAS 4.83 (SD 2.99). Statistically significant improvement was observed in both pathologies in VAS (-2.1 SD 3.1) (p 0.003). Despite the improvement in CRP, in both groups of -3.7 mg/L (SD 15) was not statistically significant. Regarding ASDAS, in the Spa group, 2 patients (5.3%) showed great improvement (&gt;3.1), 9 patients (23.7%) clinical improvement (&gt;1.1), 17 patients (42.5%) improvement (&lt;1.1), 6 patients (15%) showed no improvement and 4 patients (10.5%) worsening. The overall drug survival to date is 19.41 months (SD 13.76), 20.6 months (SD 14.8) in the Spa group and 18 (SD 12.6) in the AP group (Figure 1). Figure 1. Secukinumab survival in both groups 17 patients (23%) discontinued treatment, with a median duration of 12 months (SD 4.66). 12 (70.6%) due to ineffectiveness, 1 (5.9%) by their own decision, 3 (17.6%) due to persistent mechanical pain and 1 (5.9%) due to neoplasia (gastric adenocarcinoma). The clinical variables of metabolic syndrome were evaluated (Table 1) none of these characteristics had a statistically significant association as a cause of drug discontinuation. No patient presented infections that required discontinuation of the drug. No association was detected between drug discontinuation or the development of metabolic syndrome. Conclusion In our cohort, SCK showed a statistically significant improvement in the VAS scale in both groups. A 23.7% of patients with Spa showed clinical improvement according to ASDAS values, 5.3% showed great improvement and 42.5% showed mild improvement. The overall drug survival to date is 19.41 months (SD 13.76) slightly longer in the SpA group than in APs. SCK seems to be a safe drug as none of our patients presented infections during its use. Disclosure of Interests None declared